T E Darsaut1, C Derksen2, B Farzin3, M B Keough1, R Fahed4, W Boisseau5, L Letourneau-Guillon5, A-C Januel6, A Weill5, D Roy5, T N Nguyen7, S Finitsis8, J-C Gentric9, D Volders10, A Carlson11, M M Chow1, C O'Kelly1, J L Rempel12, R A Ashforth12, M Chagnon13, J Zehr13, J M Findlay1, G Gevry3, J Raymond14,5. 1. From the Department of Surgery (T.E.D., M.B.K., M.M.C., C.O., J.M.F.), Division of Neurosurgery. 2. Stroke Program (C.D.), Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 3. Research Center (B.F., G.G., J.R.). 4. Department of Medicine (R.F.), Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada. 5. Department of Radiology (W.B., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Montreal, Province du Québec, Canada. 6. Service de Neuroradiologie (A.-C.J.), Hôpital Purpan, Centre Hospitalier Universitaire Toulouse, Toulouse, France. 7. Service of Interventional Neurology and Neuroradiology (T.N.N.), Boston Medical Center, Boston, Massachusetts. 8. Department of Radiology (S.F.), Aristotle University of Thessaloniki, Thessaloníki, Greece. 9. Department of Radiology (J.-C.G.), Division of Neuroradiology, Centre Hospitalier Universitaire Cavale Blanche, Brest, France. 10. Department of Radiology (D.V.), Dalhousie University, Halifax, Nova Scotia, Canada. 11. Department of Neurosurgery (A.C.), University of New Mexico, Albuquerque, New Mexico. 12. Department of Radiology and Diagnostic Imaging (J.L.R., R.A.A.), University of Alberta hospital, Mackenzie Health Sciences Center, Edmonton, Alberta, Canada. 13. Department of Mathematics and Statistics (M.C., J.Z.), Université de Montréal, Montreal, Province du Québec, Canada. 14. Research Center (B.F., G.G., J.R.) jean.raymond@umontreal.ca.
Abstract
BACKGROUND AND PURPOSE: Conventional angiography is the benchmark examination to diagnose cerebral vasospasm, but there is limited evidence regarding its reliability. Our goals were the following: 1) to systematically review the literature on the reliability of the diagnosis of cerebral vasospasm using conventional angiography, and 2) to perform an agreement study among clinicians who perform endovascular treatment. MATERIALS AND METHODS: Articles reporting a classification system on the degree of cerebral vasospasm on conventional angiography were systematically searched, and agreement studies were identified. We assembled a portfolio of 221 cases of patients with subarachnoid hemorrhage and asked 17 raters with different backgrounds (radiology, neurosurgery, or neurology) and experience (junior ≤10 and senior >10 years) to independently evaluate cerebral vasospasm in 7 vessel segments using a 3-point scale and to evaluate, for each case, whether findings would justify endovascular treatment. Nine raters took part in the intraobserver reliability study. RESULTS: The systematic review showed a very heterogeneous literature, with 140 studies using 60 different nomenclatures and 21 different thresholds to define cerebral vasospasm, and 5 interobserver studies reporting a wide range of reliability (κ = 0.14-0.87). In our study, only senior raters reached substantial agreement (κ ≥ 0.6) on vasospasm of the supraclinoid ICA, M1, and basilar segments and only when assessments were dichotomized (presence or absence of ≥50% narrowing). Agreement on whether to proceed with endovascular management of vasospasm was only fair (κ ≤ 0.4). CONCLUSIONS: Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.
BACKGROUND AND PURPOSE: Conventional angiography is the benchmark examination to diagnose cerebral vasospasm, but there is limited evidence regarding its reliability. Our goals were the following: 1) to systematically review the literature on the reliability of the diagnosis of cerebral vasospasm using conventional angiography, and 2) to perform an agreement study among clinicians who perform endovascular treatment. MATERIALS AND METHODS: Articles reporting a classification system on the degree of cerebral vasospasm on conventional angiography were systematically searched, and agreement studies were identified. We assembled a portfolio of 221 cases of patients with subarachnoid hemorrhage and asked 17 raters with different backgrounds (radiology, neurosurgery, or neurology) and experience (junior ≤10 and senior >10 years) to independently evaluate cerebral vasospasm in 7 vessel segments using a 3-point scale and to evaluate, for each case, whether findings would justify endovascular treatment. Nine raters took part in the intraobserver reliability study. RESULTS: The systematic review showed a very heterogeneous literature, with 140 studies using 60 different nomenclatures and 21 different thresholds to define cerebral vasospasm, and 5 interobserver studies reporting a wide range of reliability (κ = 0.14-0.87). In our study, only senior raters reached substantial agreement (κ ≥ 0.6) on vasospasm of the supraclinoid ICA, M1, and basilar segments and only when assessments were dichotomized (presence or absence of ≥50% narrowing). Agreement on whether to proceed with endovascular management of vasospasm was only fair (κ ≤ 0.4). CONCLUSIONS: Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.
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